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mon sense can be taken for granted is a perpetually open question, and to whom it is common sense is not always so obvious (for example, Sacks 1975). |
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But ethnomethodology alone will not solve the political and organizational controversies and dilemmas of discretion. We see a link here with all previous attempts to rationally reconstruct the workplace, especially those modeling work for information systems. As Schmidt and Bannon (1992) point out, the management of real-time contingencies ("articulation work") never goes away, but if ignored, will be costly in many ways. |
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One of the battlefields where comparability and control appear as opposing factors is in linking NIC to costing. NIC researchers assert that the classification of nursing interventions will allow a determination of the costs of services provided by nurses and planning for resources needed in nursing practice settings. Currently, nursing treatments "are lumped in with the room price." In interviews with team members, they noted that although nurses fill in for physical therapists during weekends, the nursing department is not always reimbursed for this service. Sometimes the money flows back to the hospital at large, to the physical therapy department, or these treatments are simply not reimbursed. According to the NIC researchers, NIC will allow hospital administrators to determine nursing costs and resource allocation and stop such apparent "freeloading." Until it is made explicit exactly what nurses do on a daily basis, administrators have trouble rationally allocating tasks. Similarly, NIC is used in the development of nursing health care systems and communication with the classification systems of other health care providers. This coordination provides a safety net and planning vehicle for untracked costs. |
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The horizon is not fully clear, however. Wagner (1993), Egger and Wagner (1993), Gray, Elkan, and Robinson (1991), Strong and Robinson (1990), and Bjerknes and Bratteteig (1987a and 1987b) have studied the implementation of similar measures in Europe.
41 While these measures have the effect of making nursing work visible and differentiated, nurses may also become a target for social control and surveillance. Visibility here works against control in the sense of discretionary judgment and common sense. Wagner (1993) states that while computerization of care plans in French and Austrian hospitals is partly designed to give nurses greater scope of responsibility and legitimize their care giving in some detail, it also has another side: |
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